Abstract
Data for two birth cohorts from two Brazilian municipalities, Ribeirão Preto in 1994 and São Luís in 1997/1998, were used to identify and compare factors associated with inadequate utilization of prenatal care and to identify factors capable of explaining the differences observed between the two cities. Prenatal care was defined as adequate or inadequate according to the recommendations of the Brazilian Ministry of Health. The chi-square test and Poisson regression were used to compare differences in the inadequacy of prenatal care utilization. The percentage of inadequacy was higher in São Luís (34.6%) than in Ribeirão Preto (16.9%). Practically the same variables were associated with inadequacy in both cities. Puerperae with lower educational level, without a companion or cohabiting, who delivered in public health units, younger than 20 years, multiparae and smokers, with low family income presented higher percentages of inadequate prenatal care utilization. However, the effects of some variables differed between the two cities. The risk for inadequate use of prenatal care was higher for women attended in the public health sector in São Luís and for cohabiting women in Ribeirão Preto. The effect of the remaining factors studied did not differ between cities. The category of admission accounted for 57.0% of the difference in the inadequate use of prenatal care between cities and marital status accounted for 45.3% of the difference. Even after adjustment for all variables, part of the difference in the inadequacy of prenatal care utilization remained unexplained.
Highlights
Much has been done in Brazil to expand the offer of health care to mothers and their newborn infants, but situations of insufficient facilities, low quality of the services and of social inequality of access still persist [1]
Ribeirão Preto showed a higher percentage of adequate use of prenatal care (57.1%) compared to São Luís (47.3%)
The use of prenatal care was considered to be adequate when the prenatal visits started up to the 4th month and the pregnant woman performed a minimum of seven visits for a term pregnancy or a smaller number of visits according to gestational age
Summary
Much has been done in Brazil to expand the offer of health care to mothers and their newborn infants, but situations of insufficient facilities, low quality of the services and of social inequality of access still persist [1]. Important among them are the Kessner index [6], proposed in 1973, and the index proposed by Kotelchuck [7] in 1994, known as Adequacy of Prenatal Care Utilization. The latter index was adapted according to the recommendations of the Brazilian Ministry of Health in 1988 [8]. All of these indices use as reference the number of visits made during pregnancy and the month when they were started, both adjusted according to the duration of pregnancy
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